This text was obtained via automated optical character recognition.
It has not been edited and may therefore contain several errors.

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ow miiwiis.
[To be returned to the Circuit Clerk of the County in which the Birth occurs.]
If. State if still-boj'n,
5. Full name of Father, ..
5. Name of Mother previous to m arriage,..........................
7.	Nativity of Father,	............................
8.	Nativity of Mother,	.......................
I hereby certify that the above is a true return of the Birth and other facts above recarded.
Dated at „ . ~
Con nil/ of	....... Miss.,
...187
Residence ....
this..
my u/	i
w.,.day of......6
..,
t Attending Physician,
* State whether White, Black, Mulatto, Indian or other Races.
f Strike out these words if the Return be made by some other person, and add other explanatory words.
j